Drug-Coated Balloon Angioplasty and Debulking for the Treatment of Femoropopliteal In-Stent Restenosis: A Systematic Review and Meta-Analysis

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2020 Jun 30

PMID 32596293

Citations 4

Authors

Zhu Tong

Lianrui Guo

Lixing Qi

Shijun Cui

Xixiang Gao

Yang Li

Jianming Guo

Yongquan Gu

Affiliations

Soon will be listed here.

Abstract

The purpose of this article was to compare the efficiency and safety of drug-coated balloon angioplasty (DCB) and atherectomy with percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal in-stent restenosis (ISR). Pubmed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) (all up to March 2019) were searched systematically. Trial sequential analysis (TSA) was conducted. 5 studies with 599 participants were included. Compared with PTA, DCB significantly increased the rate of patency (6 months: RR 1.65, 95% CI 1.30 to 2.09, < 0.01; 12 months: RR 2.38, 95% CI 1.71 to 3.30, < 0.01) and the rate freedom from target lesion revascularization (TLR) (6 months: RR 1.18, 95% CI 1.09 to 1.28, < 0.01; 12 months: RR 1.56, 95% CI 1.33 to 1.82, < 0.01) at 6 and 12 months follow-up, and the TSA results showed these outcomes were reliable. The rate of clinical improvement by ≥1 Rutherford category in the DCB group was higher than that in the PTA group (6 months: RR 1.35, 95% CI 1.03 to 1.75, = 0.03; 12 months: RR 1.46, 95% CI 1.17 to 1.82, < 0.01) at 6 and 12 months. There is no statistically difference of ABI, all-cause mortality, and incidence of amputation between DCB group and PTA group (MD 0.03, 95% CI -0.03 to 0.08, = 0.40; RR 1.24, 95% CI 0.46 to 3.34, = 0.67; RR 0.32, 95% CI 0.01 to 7.61, = 0.48). Compared with PTA, the rate of patency and freedom from TLR in the laser atherectomy (LD) group was higher than that in the PTA group (patency: 6 months: RR 1.28, 95% CI 1.01 to 1.64, < 0.05, 12 months: RR 2.25, 95% CI 1.14 to 4.44, < 0.05; freedom from TLR: 6 months: RR 1.27, 95% CI 1.05 to 1.53, = 0.01, 12 months: RR 1.59, 95% CI 1.12 to 2.25, = 0.01) at 6 and 12 months follow-up. In conclusion, DCB and LD had superior clinical (freedom from TLR and clinical improvement) and angiographic outcomes (patency rate) compared with PTA for the treatment of femoropopliteal ISR. Moreover, DCB and LD had a low incidence of amputation and mortality and were relatively safe methods.

Citing Articles

Debulking plus drug-coated balloon angioplasty versus drug-coated balloon angioplasty alone for femoropopliteal Tosaka III in-stent restenosis lesions.

Li L, Tong Z, Cui S, Guo L Wideochir Inne Tech Maloinwazyjne. 2023; 18(1):166-172.

PMID: 37064559 PMC: 10091921. DOI: 10.5114/wiitm.2022.119936.

In-stent restenosis of superficial femoral artery: use all arrows in the quiver.

Vadala G, Ceresa F, Costa F, Bottari A, Roscitano G, Patane F Oxf Med Case Reports. 2022; 2022(10):omac108.

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The Diagnostic Value of Circulating Biomarkers and Role of Drug-Coated Balloons for In-Stent Restenosis in Patients with Peripheral Arterial Disease.

Montelione N, Catanese V, Nenna A, Jawabra M, Verghi E, Loreni F Diagnostics (Basel). 2022; 12(9).

PMID: 36140608 PMC: 9498042. DOI: 10.3390/diagnostics12092207.

Percutaneous Mechanical Atherectomy Plus Thrombectomy Using the Rotarex®S Device Followed by a Drug-Coated Balloon for the Treatment of Femoropopliteal Artery In-stent Restenosis: A Prospective Single-Center, Single-Arm Efficacy Trial (PERMIT-ISR....

Liu M, Li W, Guo X, Zhang Z, Liu B, Yu H Front Surg. 2021; 8:671849.

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